- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $128.82 / $181.97
| Facility | | $120.23 | $128.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $295.12
| Professional | | $107.15 | $154.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $104.71 / $234.42 / $346.74
| Professional | 25 | $104.71 | $234.42 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $380.19 / $1,412.54
| Facility | | $97.72 | $380.19 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $354.81 / $588.84
| Professional | | $199.53 | $354.81 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $537.03 / $1,479.11
| Facility | | $363.08 | $537.03 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $234.42
| Professional | | $144.54 | $181.97 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $588.84 / $1,174.90
| Facility | | $389.05 | $588.84 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $165.96 / $186.21
| Professional | | $141.25 | $165.96 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $380.19
| Facility | | $125.89 | $190.55 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $309.03 / $831.76
| Professional | | $144.54 | $309.03 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $354.81 / $436.52 / $575.44
| Professional | 25 | $354.81 | $436.52 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $245.47 / $436.52
| Professional | | $125.89 | $245.47 | $436.52 |